Specialized Travel Consultation Part I: Travelers' Prior Knowledge

Electronic consultations with Video Supported PowerPoint versus in-clinic face-to-face, pre-travel consultations: A single-centre, comparative analysis

BACKGROUND

Pretravel consultation involves a face-to-face visit with a Travel Medicine expert and includes time consuming educating/counseling. Efficacy of electronic consultations for pretravel is unknown. We compared pretravel education via face-to-face consult to an electronic consultations combined with education via Video Supported PowerPoint for select travelers.

METHODS

We conducted a prospective trial comparing pre-travel education via electronic consultations versus face-to-face consult. Study was conducted from May 2014 through May 2015.

RESULTS

Pretravel surveys were completed by 100 in electronic consult arm and 94 in face-to-face consult arm; 67/100 (67%) in the electronic consult and 51/94 (54.2%) in the face-to-face group completed post-travel surveys. Both groups had similar baseline demographics. 36.2% of the face-to-face group felt the trip preparation could have effectively been accomplished through electronic consult, while 33% felt that a face-to-face consult was needed; in contrast, a majority (63.3%) of electronic consult group preferred the electronic consult. Pre-travel education effectiveness was similar in both groups. No statistically significant differences in responses were noted in both groups to 5 of the 6 knowledge assessment questions. A higher proportion (76/100; 76%) in the electronic consult group compared to 55.4% (51/94) (p = 0.0018) in face-to-face group chose the correct response regarding management of febrile bloody diarrhea. 53% reported behavior change to prevent travel related illnesses, with no statistically significant differences between the groups.

CONCLUSIONS

electronic consultation with Video Supported PowerPoint pre-travel education is as effective as education via face-to-face consultations and provides a viable alternative to face-to-face consultations in select travelers.

Tour leaders with detailed knowledge of travel-related diseases play a key role in disease prevention

In Taiwan, group tours are a popular mode of international travel; hence, group tour leaders must ensure traveler safety and health. This study identified factors influencing tour leaders' willingness to recommend pretravel medical consultation and vaccination.A cross-sectional questionnaire survey was administered to tour leaders from January 2011 to December 2012. Multivariate logistic regression analyses were performed to estimate the odds ratios of having a positive attitude and willingness based on different knowledge scores of the tour leaders after adjustments for age, sex, education level, and seniority.Tour leaders with a more detailed knowledge of both travel-related infectious and noninfectious diseases demonstrated a higher willingness to receive vaccination. They believed that consultation at travel clinics before travel can improve travelers' health (P < .05).This study supports the importance and effectiveness on educating tour leaders' knowledge about travel-related diseases to improve health care for travelers.

Travel risk behaviors as a determinants of receiving pre-travel health consultation and prevention

BACKGROUND

An estimated 30-60 % of travelers experience an illness while traveling. The incidence of travel-related illness can be reduced by preventive measures such as those provided by the Traveler Health Clinic (THC) in Kuwait.

METHODS

The present study is an analytical comparative study between groups of travelers visiting the THC during the study period (May 2009 - December 2010) and an age- and gender-matched control group of non-visitors (800 people). Both groups completed a modified pre-departure questionnaire.

RESULTS

Bivariate analysis revealed that Kuwaitis (68.2 %), those traveling for work (25.3 %) or leisure (59.5 %), those living in camps (20.4 %) or hotels (64.0 %), and those with knowledge of the THC from the media (28.1 %) or other sources (57.3 %), were more likely to be associated with a high frequency of visits to the THC (p < 0.001). Additionally, travelers heading to Africa (47 %) and South America (10 %) visited the THC more than did others (P < 0.05). Multivariate analysis revealed that nationality, followed by purpose of travel, duration of stay, and choice of travel destination are independent predictors of receiving pre-travel consultation from the THC.

CONCLUSION

Nationality, purpose of travel, length of stay, and travel destination are predictors for receiving a pre-travel consultation from the THC.

Impact of advice given to travelers concerning the main infectious risks associated with traveling in the tropics

INTRODUCTION

The prevention of sanitary risks related to traveling in the tropics implies delivering a large amount of information to travelers. The objective of our study was to assess the knowledge acquired by travelers during a pre-travel consultation.

METHODS

A before and after study was conducted among 202 travelers having consulted at the Tours international vaccine center. We used self-administrated questionnaires (score out of 100 marks) concerning diet, hygiene, anti-vectorial prevention (AVP), and sexual-transmitted infections (STI). The scores obtained before and after consultation were compared globally and for each topic.

RESULTS

The travelers' global knowledge had improved after consultation (66.1 vs. 75.5%; P < 0.0001) as well as for each topic. The most important improvement concerned hygiene (+12.5%; P < 0.0001) and the lowest concerned STI (+5.8%; P < 0.0001). The multivariate analysis revealed that not having searched for information before consulting was the main factor associated with global knowledge improvement (P < 0.0001) (unplanned professional traveling compared to humanitarian mission prepared ahead of departure time). The recommendations for diet were less well acquired in travelers > 50 years of age than in those < 30 years of age (P < 0.002).

CONCLUSION

A specialized pre-travel consultation improves the travelers' knowledge for the main prevention measures but does not allow them to acquire all required knowledge. Taking into account the travelers' initial knowledge and their ability to learn could improve the impact of the pre-travel consultation.

Immediate recall of health issues discussed during a pre-travel consultation

BACKGROUND

An important role of pre-travel consultations is to improve travelers' understanding of travel-related diseases, but the efficacy of education provided is unknown. This study sought to assess recall and knowledge immediately following a pre-travel consultation.

METHODS

The study was conducted at a hospital-based pre-travel clinic in Melbourne, Australia. Travelers aged ≥16 years seen between September 2010 and March 2012 were invited to complete an anonymous self-administered questionnaire immediately following their consultation to assess knowledge of appropriate preventive measures and presumptive self-treatment strategies for common travel risks. The doctor of each participating traveler also completed a survey regarding issues discussed.

RESULTS

A total of 300 participants were recruited (34% male, median age 31 years). Most were traveling for vacation (77%) and reported previous travel (95%). Main travel destinations were Asia (43%), Americas (21%), and Africa (17%). Doctors' and travelers' surveys showed variable levels of concordance: 94% of patients recalled discussion of malaria, 84% rabies, and 76% dengue. For malaria, 95% remembered discussions regarding insect repellents, and 92% recalled that medical advice should be sought if fever developed. For travelers with whom rabies was discussed, 94% recalled that medical advice must be urgently sought following a bite/scratch. For travelers' diarrhea (TD), 99% knew to drink only boiled/bottled water, but 13% did not recall avoiding unpeeled fruit/vegetables as a prevention strategy. There was 20% discordance between doctors and travelers regarding antibiotics for TD self-treatment, but only 4% discordance regarding prescription of malaria prophylaxis. Factors associated with improved recall were doctor discussion, previous travel, and a university education.

CONCLUSIONS

Key travel health messages are well assimilated after pre-travel consultation. However, large amounts of information are discussed and immediate recollection of all information is not possible. This study reinforces the importance of providing supplementary information (eg, written and/or electronic resources) to accompany pre-travel consultations.

Knowledge, attitudes, and practices among foreign backpackers toward malaria risk in southeast Asia

BACKGROUND

Malaria is still prevalent in Southeast Asia where large numbers of backpackers visit each year. This study aimed to assess the knowledge, attitude, and practices among foreign backpackers toward malaria risk in Southeast Asia.

METHODS

Questionnaires were administered to foreign backpackers in Bangkok, Thailand. They were asked about their general background, their attitude to malaria risk, and their preventive measures against malaria. Their knowledge about malaria was assessed by 10 true-false questions in the questionnaires.

RESULTS

In total, 434 questionnaires were evaluated. Fifty-five percent of travelers were male and the median age was 28 years. The main reason for travel was tourism (91%). Almost all travelers (94%) were aware of the risk of malaria. Twenty-two percent of them would take antimalarial prophylaxis and 33% would use measures against mosquito bite, but nearly 40% had "no prevention" at all. Mean knowledge score was only 5.52 of 10. Most backpackers (92%) knew that malaria is a serious disease and sometime fatal and 74% knew that some travelers could develop malaria after they return. However, up to 35% believed that eating contaminated food could lead to malaria infection. And 49% believed that malaria could be 100% prevented by chemoprophylaxis. In backpackers, who had traveled in the forest (n = 65), only 54% used insect repellent regularly. Among those who had taken antimalarial prophylaxis, nearly 30% had stopped the medication prematurely.

CONCLUSIONS

Although most backpackers perceive the risk of malaria in Southeast Asia, they have some misunderstandings about malaria and tend to comply poorly with mosquito bite prevention and chemoprophylactic strategies.

[Management of vaccinations and prophylaxis of international travellers from community pharmacy (VINTAF study)]

OBJECTIVES

To improve and evaluate the travel advice by community pharmacists.

DESIGN

Cross-sectional and prospective study.

SETTING

Community pharmacies from Asturias, Barcelona, Madrid and Valencia.

PARTICIPANTS

483 travellers to high health risk countries who visit the community pharmacies and were agreed with the aims of the study.

METHOD

Community pharmacists gave information regarding immunization and prophylaxis about travel-related disease according to the destination, type and duration of travel and other features of the tourist (age, taking medicines, diseases, etc.).

MAIN MEASUREMENTS

Destination, adherence to the prophylaxis and vaccinations recommended, adverse effects and diseases the tourists have in the travel and one month after they are back.

RESULTS

Only 6.3% of the travellers were effective vaccinated and took prophylaxis (all vaccines and prophylaxis according to the destination). 36.2% of the travellers experienced an illness while abroad. The commonest disease were travellers' diarrhoea (15.7%). The pharmacists were the only source of information about sunscreens, repellents, and other sanitary goods.

CONCLUSIONS

The community pharmacists can give accurate information regarding immunization and prophylaxis about international travels. It is necessary to improve the communication between family physician, the tropical travel clinic and community pharmacists in order to improving compliance. It is necessary keep the bureaucratic barriers away to get this kind of drugs. The international tourists still travel without the necessary vaccines and prophylaxis to the high health risk areas.

A population-based comparison between travelers who consulted travel clinics and those who did not

BACKGROUND

Travel to hepatitis A-endemic countries is frequent among North Americans. Such travel carries significant risks for the individuals themselves and for the general population. We documented the patterns of use of travel clinics in a large Canadian adult population.

METHODS

Travelers who had visited a hepatitis A-endemic country between 1990 and the time of the survey in 1999 were eligible. Subjects were identified from a representative sample of 4,002 adults from the two largest Canadian provinces. They were contacted by random digit dialing and interviewed by telephone.

RESULTS

Only 15% of trips had been preceded by a visit to a travel clinic. The probability of visiting a travel clinic was approximately 10 times greater for travelers considered to be in the high-risk category than for those in the low-risk category, but the former represented only 2% of the total. The probability of visiting a travel clinic was approximately 23 times greater for travelers who were aware of the health risks in their country of destination. Income level was not associated with attendance at a travel clinic, and cost was rarely mentioned as a reason for not attending such a travel clinic before departure.

CONCLUSIONS

Each year, millions of Canadian travelers go to hepatitis A-endemic countries without consulting a travel clinic. Active steps must be taken by public health authorities to improve their utilization of health services and prevent the accrued health risk for these travelers.

The prevention of malaria

Long before the advent of modern chemoprophylaxis drugs, many practitioners successfully prevented the debilitating and fatal outcomes associated with infection by the Plasmodium parasites that cause malaria. Today, with effective insect repellents and several excellent medications available for chemoprophylaxis, there has never been a better array of quality products to prevent mosquito bites and infection and to suppress parasites once in the blood stream; however, there are thousands of imported cases into nonendemic countries and scores of deaths and near-fatal outcomes every year in returning travelers, soldiers, immigrants, and refugees. In this article, the author focuses on practical uses of currently available prevention tools.

Perception and knowledge about some infectious diseases among travelers from Québec, Canada

BACKGROUND

Many travelers from Québec visit tourist destinations, thereby becoming at risk of infectious diseases. Within a study of predictors of utilization of travel health consultation by travelers, knowledge about transmission and perception of risk and severity of some infectious diseases was measured.

METHODS

A cross-sectional survey was conducted during winter 1999 on travelers 16 years of age and over going to Mexico and the Dominican Republic. A 34-item self-administered bilingual questionnaire was distributed to travelers during seven flights departing from Montréal Airport.

RESULTS

The questionnaires were completed by 1,724 passengers (response rate: 75%). The majority (81%) of the 1,416 travelers from the province of Québec considered themselves at greater risk of diarrhea abroad. Risk perception was less important for hepatitis A and B (44% and 41%, respectively). Most travelers considered diarrhea as slightly or not severe, and hepatitis as severe illnesses. A majority had adequate knowledge about transmission of diarrhea but knowledge concerning hepatitis was less accurate. In the multivariate analysis, the most important associations were noted between perception of risk of diarrhea and knowledge about transmission of diarrhea (odds ratio [OR] 3.2); and between perception of risk of hepatitis and perception of severity of hepatitis (hepatitis A: OR 3.9; hepatitis B: OR 5.9). Consultation in a travel clinic before departure was associated with perception of higher risk of hepatitis A and of infectious diseases in general (OR 2.1).

CONCLUSION

Despite its limitations, this study indicates that travelers from Québec, going to sun destinations, seem to underestimate their risk of hepatitis related to travel. Knowledge about transmission of hepatitis seems poor. Education of travelers about risks and modes of transmission of infectious diseases should be reinforced. Travel health consultation before departure or for a previous trip appeared to be associated with higher risk perception.

Vaccines for travelling minors: The 'shot' heard around the world

The number of adults, children and adolescents who travel from the industrialized world to less industrialized countries for work or pleasure is steadily increasing. Travel immunizations for children are a critical element of pretrip planning. Occasionally, one of the most daunting aspects of an exotic trip or a foreign posting can be the logistics (and recriminations) associated with getting the family to a travel medicine clinic with sufficient lead time to ensure that all of the necessary immunizations are given before departure. The present paper reviews pertinent immunization information from three points of view: the travel clinic, the parent and (with license) the child.

Predictors of pretravel consultation in tourists from Quebec (Canada)

BACKGROUND

Although many tourists from Quebec (Canada) each year visit destinations at risk for infectious diseases, only a few of them seek travel health advice. To identify the determinants of travel health consultation, we conducted a study among Quebec's tourists visiting two popular sun destinations.

METHODS

A conceptual model based on psychosocial determinants of human behavior was constructed. A cross-sectional survey was carried out, from January to April 1999, on two samples of travelers planning to visit Mexico and the Dominican Republic. One sample was composed of people who did not consult a travel clinic (cluster sampling in seven flights), and the other sample was one of clients of travel clinics (purposive selection of 13 specialized clinics located in Quebec). A 34-item self-administered bilingual questionnaire was distributed to travelers. Statistical analysis included a multivariate approach (logistic regression).

RESULTS

A total of 2,242 travelers were surveyed (response rate in flight 75% and in clinics 99%). We present only results reported by French-speaking tourists: 1,152 who did not consult a travel clinic and were reached in flight, and 449 who were reached in clinics. Multivariate analyses indicated that travel agent recommendation was the most important predictor of consultation among travelers (OR 8.0, 95% CI 5.1-13), especially among those under 45 years of age and those who never sought pretravel consultation before (OR 21, 95% CI 11-41). Other important predictors were: traveling for the first time, traveling with children, previous consultation, perception about efficacy of immunization, risk perception, and information from travel agent, family doctor, and pharmacist.

CONCLUSIONS

Despite its limitations, this study provides data that should help improve public health interventions aimed at encouraging travelers to get a pretravel consultation.

Health problems of corporate travelers: risk factors and management

BACKGROUND

Numerous studies have been done regarding health problems experienced by tourists in developing countries; however, little data exist about these health risks and illnesses experienced by corporate travelers.

METHODS

The authors examined by electronic survey the health risks encountered, compliance with pretravel health recommendations, and illnesses and injuries experienced by employees of the Coca-Cola Company who travel internationally.

RESULTS

Two hundred twenty-six travelers responded. Although most travelers ate meals at their hotels and chose foods that were cooked and still hot, over half also ate foods that remained at room temperature for prolonged periods and/or ate from cold salad bars. Almost half drank untreated tap water. Thirty-five percent of travelers developed diarrhea and 29% reported respiratory illnesses, with 12% seeking medical attention for their problems. Forty-three percent of those traveling to malarious regions admitted to noncompliance with antimalarial recommendations. Health kits provided were used by only 51% of travelers.

CONCLUSIONS

Although many corporate travelers followed pretravel health recommendations, some did not. Injuries, fever, and illnesses such as diarrhea and respiratory infections occurred. Strategies to improve access to the travel clinic and the acquisition of health information and travel health kits are being implemented. The health risks and behaviors of corporate travelers, including the potential impact of psychosocial stressors, need greater attention.

Primary health care needs for travel medicine training in Britain

BACKGROUND

In the UK, travel health advice is mainly provided by practice nurses and general practitioners (GPs). The need for their improved education in travel medicine has been highlighted through previous studies and by an increasing number of requests for training.

METHODS

A questionnaire-based survey of 3900 GP practices was conducted to assess training requirements and to establish the demand for an academic course in travel medicine. 1430 (37%) questionnaires were completed.

RESULTS

93% of practices provided a pretravel advice service. 87% of GPs advised an average of 10 travelers per month and only 48% immunized travelers. 98% of nurses advised and immunized an average of 28 travelers a month. 21% of GPs and two-thirds of nurses had attended one or more training sessions in travel medicine. Over 90% of the sample (83% of GPs and 98% of nurses) expressed an interest in attending a formal training program in travel medicine. Eligibility for Post Graduate Education Awards (PGEA) was important for most GPs (88%). Nurses valued approval by the English National Board for Nursing (88%) and a system of Credit Accumulation & Transfer (CATS) (82%). Funding for a course would be met in full by 18% of respondents (mainly GPs) and a further 20% would contribute to fees. Most GPs and nurses have ready access to a range of information sources, e.g., a postgraduate medical centre (85%) and a medical library (91%). Computerized access to information was feasible as 93% had a computer and 54% had a modem attached.

CONCLUSIONS

The discipline of travel medicine is becoming increasingly specialized. Future practitioners will need to enhance their skills to meet the demands of today's travelers. Our results show that general practice staff are keen to develop such skills. Specialist training courses need to be expanded to meet this demand.

Illness in Journalists and Relief Workers Involved in International Humanitarian Assistance Efforts in Somalia, 1992-93

Background: Journalists and relief workers participating in international relief efforts in Somalia following the intervention of outside armed forces in late 1992, were faced with a number of threats to their health. Principally these threats were from endemic infectious diseases and trauma. Methods: In-patient, emergency clinic, and laboratory records of U.S. military field hospitals, which provided the only available sophisticated medical care in Somalia during most of the study period (December 15, 1992, to February 15, 1993), were reviewed to determine the number of workers evaluated and the causes of their illnesses. In addition, two questionnaire surveys were conducted to elucidate risk factors for illness in these groups. Results: One hundred and thirty-eight journalists and relief workers, primarily from Europe and North America, were evaluated at a hospital for a variety of common travel-associated health problems, including diarrhea (33%), acute respiratory infection (21%), other febrile illnesses (11%), hepatitis (2%), major trauma (6%), and minor trauma (13%). Documented infectious disease pathogens included Plasmodium falciparum (7 cases), Shigella sp (3 cases), enterotoxigenic Escherichia coli (ETEC) (3 cases), dengue virus-2 (2 cases), and hepatitis E virus (3 cases). Two relief workers were killed by gunshot wounds. In the questionnaire surveys of 104 journalists and 98 relief workers, 84% of respondents reported that they had received some pretravel medical advice, but only 70% sought a medical consultation in person. Thirty-four percent were not receiving a recommended antimalarial chemoprophylaxis regimen, and only 10% obtained a fluoroquinolone antimicrobial drug for self treatment of diarrhea. Sixty-four percent of both groups combined, reported having had diarrhea, and 26% experienced a nondiarrheal febrile illness. Sixty-eight percent reported that their work performance was adversely affected by illness. In multivariate logistic regression analyses, factors associated with an increased risk of diarrhea were age < 35 years (OR 1.5, 95% CI 1.1-1.9); residence in Somalia for more than 21 days (OR 1.7, 95% CI 1.3-2.1); and regular consumption of local food and water (OR 3.8, 95% CI 3.4-4.2). Factors associated with nondiarrheal febrile illness were age < 35 years (OR 1.4, 95% CI 1.1-1.8); residence in Somalia for more than 21 days (OR 1.8, 95% CI 1.4-2.2); and not having had an in-person pretravel medical consultation (OR 2.0, 95% CI 1.5-3.0). Conclusions: These data indicate that journalists and relief workers who traveled to Somalia in response to the massive humanitarian crisis themselves experienced substantial health problems. Improved pretravel medical preparation might prevent or limit illness in these unique groups and improve the efficiency of future disaster response efforts. (J Travel Med 2:70-76, 1995)

Specialized Travel Consultation Part II: Acquiring Knowledge

With an increase in travel to tropical countries, the need to improve the disease-risk perceptions of travelers who are either naive or given inappropriate or ineffective advice is becoming increasingly important. More widely available, specialized centers that can provide advice on tropical or travel-related diseases have been established, but their efficacy on travelers' knowledge and health has not been verified. Therefore, this study was undertaken to evaluate the impact of the service provided by a routine travel consultation at the Hospital for Tropical Diseases Travel Clinic, London, England. Self-administered questionnaires were given to 161 preconsultation and 144 postconsultation clients. The consultation included an interview covering travel plans and immunization and medical history, and advice was given on the journey, necessary immunizations, and prophylaxis. Data were analyzed using the Statistical Analytic System software and the mean differences in knowledge between pre- and postconsultation scores were correlated using the nonparametric Mann-Whitney procedure. The control of mutually confounding factors was maintained by multiple regression using the Mantel-Haenszel summary chi-square and the General Linear Model procedures. Comparison of the entry and exit scores showed a significantly improved overall knowledge of travel-related diseases in the exit, postconsultation group. Subanalysis revealed that this difference was due to an increased knowledge of malaria and its prevention and perceived risk of cholera. Knowledge about the management of diarrhea or fever, however, was not significantly improved by a consultation. Inexperienced travelers taking packaged or organized trips, and those from socioeconomic groups I and II showed the largest increase in knowledge following consultation. Our results show that a face-to-face interview for an average of 18 minutes by trained staff is an effective way of improving travelers' knowledge on certain topics. The slight improvements overall are explained by the levels of experience of travel and previously acquired knowledge of the clients in our study. Effective advice on malaria prevention and some health risks is given during an average consultation; however, there is still a need for improvement in giving information on the management of diarrhea, fever, and other travel diseases.